Monday, June 16, 2008

Britain's child victims of the chemical cosh

Powerful anti-psychotic drugs designed for adults are being used to treat children.

[chemical cosh - n. a drug or mix of drugs used to subdue a patient, prisoner, or other person.]

By Brian Brady and Nina Lakhani

Sunday, 15 June 2008

The number of powerful psychiatric drugs prescribed to England's children has risen by more than half in four years, government figures have revealed.

GPs in England are handing out prescriptions for anti-psychotic drugs for children as young as seven at the rate of 250 a day, according to figures obtained by The Independent on Sunday.

Latest data compiled for the NHS show that tranquillisers designed to treat serious conditions including schizophrenia in adults were prescribed to young people 57,000 times in 2003. But the total had risen to more than 90,000 by 2006 – a 59 per cent rise in three years. The figures do not include drugs dispensed in hospitals. Experts believe the increase is partly down to early detection and treatment of serious mental health problems in children, but there is also concern they are being used inappropriately to treat psychological and learning difficulties. Shortage of staff and resources are further factors.

The drugs, which are designed to treat symptoms such as visual hallucinations, hearing voices and delusional thoughts, have serious side effects including weight gain, tiredness, sexual dysfunction and lactation. The safety and effectiveness of these drugs, which were designed for adults, have not been fully tested on children.

Official guidelines say they should be used only as part of a wider treatment package, but there are concerns GPs are relying on them too heavily because other treatments are unavailable. Some GPs, however, stand accused of ignoring or being ignorant of the guidelines.

England's mental health chief, Louis Appleby, said, "We are aware that anti-psychotic drugs are sometimes used as a last resort by clinicians dealing with highly disturbed behaviours in young people, and we are now considering how to prepare clinical guidance on this area of practice."

Psychiatrists and mental health charities have warned against using anti-psychotic drugs on developing minds. Paul Corry, director of public affairs for the mental health charity Rethink, said: "It is worrying that these very powerful drugs designed for adults are being given in such high numbers to children before their brains are fully developed.

"If the increase is because previously undiagnosed teenagers are now getting treatment, then that is positive. But it is difficult to justify the widespread use of these drugs in younger children because it is actually unlikely they will have schizophrenia at such a young age."

Anti-psychotics are commonly used to treat conditions including schizophrenia, mania and delusional disorder by blocking the chemical dopamine in the brain. But they have also been widely used for their "calming" effects in other conditions, such as autism and hyperactivity.

MPs and pressure groups have already complained about the use of anti-psychotic drugs in care homes to manage people with dementia – often to treat "behaviour that is neither distressing nor threatening, such as restlessness or being vocal".

But experts have raised further concerns about their growing use on young people. A study by the University of London's School of Pharmacy last month found that the prescription of the drugs to children almost doubled between 1992 and 2005 – with the greatest increase among children aged seven to 12.

Figures provided for the IoS from the NHS Prescription Cost Analysis (PCA) system prove that the trend has continued to rise dramatically. The increase in costs can be partly explained by the move towards prescribing newer or atypical drugs, which are more expensive but generally have fewer and less severe side effects.

But mental health campaigners are outraged by the number of older, typical drugs such as chlorpromazine and haloperidol still being prescribed. There were more than 7,000 prescriptions for these two drugs, widely known as a "chemical cosh", in 2006, which means nearly 20 prescriptions every day.

According to Rethink, there is no excuse for prescribing these powerful drugs and they should have been phased out. Mr Corry said: "The use of these older drugs is just wrong. There is no excuse at all. They may be cheaper but they are associated with some of the most debilitating and stigmatising mental healthcare from the 20th century, which led to people behaving like zombies."

Guidelines from the National Institute for Clinical Excellence (Nice) state that atypical anti-psychotics should be the first choice for treatment for young people, who should be given all necessary information to make an informed choice about treatment. Many young people complain they are not warned about the side effects.

When Elaine Hewis's teenage daughter was admitted to a psychiatric hospital in 2004, she assumed the treatment would be far removed from that she herself had received. But Mrs Hewis, 43, was wrong. She said: "The doctors had prescribed her anti-psychotics within days. But despite my pleas they refused to tell her about the side effects because they were worried she wouldn't take them if she knew.

"When she came to me distressed because her breasts were leaking milk, I told her this had happened to me and again tried to get the doctors to be honest with her. They then tried to remove me as her nearest relative because they felt I was a bad influence."

New teams have been brought in to catch cases early. Psychiatrists and nurses would work closely with teachers, youth workers, school nurses, family therapists, social workers and psychologists. While progress has been made, the reality is that many of these teams have few resources and the emphasis is often on drug treatments.

Mr Corry said: "It is a crying shame because early intervention is one of the rare parts of mental health with an evidence base. If we get to people early and treat them with a combination of psychological, social and medical intervention, then their chances of a full recovery increase dramatically. But you need to do all of these things, not just the medication."

Clinical psychologist Rufus May was treated with anti-psychotics as a teenager. He believes the drugs stop a young person from understanding their symptoms and from learning skills to manage difficult experiences by trying to block them out. He said: "The early intervention movement has turned into the early drugging movement. These very powerful drugs can affect the emotional and cognitive development of a young person as well as sapping them of their confidence and motivation."

But psychiatrists argue the rise in prescribing to children represents a success. Young people are being treated earlier.

Professor Sue Bailey from the Royal College of Psychiatrists said: "This increase reflects the development of better adolescent mental health services, which means ill children are being identified earlier, and we are going in more assertively with a treatment package that includes medication.

"Early identification and treatment lead to better outcomes. The real difficulty we face is convincing young people to take the medication and stay compliant."

'No one ever talked about side effects with me, not once'

Lucy Bennett, 19, from Exeter, lives with her seven-month-old son Harvey. For a year she lived in psychiatric hospitals with medication the only option.

"By the time I was 15 I had every problem you can imagine. I was into drugs, alcohol, boys, and had stopped going to school. After years of growing up with my mum's mental illness and alcohol problems, I was on a road to self-destruction. I finally told a psychiatrist in A&E I was hearing voices after which I was admitted to hospital straight away.

"I felt terrible. I was all over the place, so when the doctors and nurses told me the medication would make me feel better, I took them. In some ways I did feel a bit better. I was a complete zombie and sleeping all the time which meant I didn't care about the voices any more, but they were still there.

"Within days I had started leaking milk from my breast. It was awful. I swapped medication and within three months I had put on three stone. I was so depressed at being a size 16 I started making myself sick. I ended up with bulimia as well.

"As soon as I decided I didn't want to take the drugs I was sectioned and forcibly injected. I ended pretending the voices had gone just so I could get out. Drugs were the only option. I had a psychology session for an hour a week and a few family therapy sessions but that was it. No one ever talked about side effects with me, not once. I ended up having to get information from my mum and other patients.

"Three years later I am medication free and learning new ways to cope with my voices. I have a great community psychiatric nurse, who lets me keep some medication for emergencies, but I'm in control now. There is no way I could look after my son if I was still on the medication. I know they can help some people but they didn't help me. I should have been given the choice."